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•) <br />0 <br />N <br />Q <br />z <br />z <br />z <br />NON -HAZARDOUS WASTE MANIFEST <br />4lease v"rWor tvpa (Form desirtned for use on elite (12 P 1 typotniter) <br />GF14 0 2002 LAllELNSA5TERp (800) <br />NON -HAZARDOUS <br />t. Generator's US EPA ID No. <br />Manifust <br />2. <br />Page t <br />WASTE MANIFEST <br />Document No. } - <br />i ,t3`.r't <br />or <br />3. Generators Name and Mailing Address <br />taxi r.;r''44tYt;z:6i�ri <br />4. Generators Phono ( <br />5. Transporter 1 Company Name 6. <br />US EPA ID Number <br />A. State Transporters ID <br />:t it:'tilsl.'.iirltyrll:<i('alaw;.1"jgdUf€` f,?it1) <br />1° <br />i. ;sjf�ii t(i:'i.j�` i`• <br />IS;.i <br />B. Transporter I Phone .('Im <br />7 Transperler 2 Company Name 6. <br />US EPA ID Number <br />C. State Transporter's ID <br />Mims <br />D. Transporter 2 Phone <br />9. Designated Facility Name and Site Address 14. <br />US EPA ID Number <br />E. State Faczlltys ID t E t <br />i:146iiis.'t (ilial <br />1...: S.:t���t6�('F <br />Clrr:tji' <br />F.FacilitysPhone <br />I I. WASTE DCSCRIPTION <br />Containers <br />13. <br />14. <br />Total <br />Unit <br />No. <br />Type <br />Quantity <br />WI.NaL <br />Na:l1T iSL,{> i 7:.I;'.tE , ilsllk }i@ <br />rr <br />' <br />G <br />b <br />E <br />N <br />E <br />R <br />e <br />A <br />T <br />O <br />R <br />d. <br />G Additional De:criplmns for Materials Listed Above <br />it. Handling Codes for Wastes Listed <br />Above <br />15. Special Handling Instntclicns and Additional talomtation <br />%Ww"m <br />mtww" may" <br />",w"M <br />W"M <br />AV M <br />16. GENERATOR'S CERTIFICATION: I hereby certify that the contents of this shipment <br />are rallyy and accurately described and are in <br />all respects <br />In proper condition for transport. The materials described on this manifest are not subject <br />to Iederal hazardous waste <br />regulations. <br />Date <br />Print pi/Typed Name <br />Signature <br />hfo nth <br />Day Year <br />r t <br />' <br />17. Transporter f Acknowledgemem of Receipt of Materials <br />: <br />Date <br />R <br />N <br />Printed/Typed riffib ! f <br />Signature ��r <br />+ <br />j <br />hkonth <br />Day_ Year <br />�_ <br />! <br />M1 <br />rk4 <br />// <br />P <br />O <br />16. Transporter 2 Acknowledgement of Receipt of Materials <br />Date <br />R <br />T <br />PrintoWtyped Name <br />Signature <br />Month <br />Day Year <br />E <br />R <br />19 Discrepancy Indication Space <br />A <br />C <br />20. Facility Ovmcr or Operator Cedilication of receipt of the waste materials covered by this manifest, except as noted <br />in item 19. <br />( <br />Date <br />T <br />Prinled/Typed Name <br />Signoluret <br />hronth <br />Day Year <br />Y <br />621-5808 wwtv.lab©Imaster.com <br />ry>[Y� �'F elem <br />.SOY�NK� <br />